High recent PrEP adherence with point-of-care urine tenofovirtesting and adherence counselling among young African women:results from the INSIGHT cohort

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dc.contributor.authorGati Mirembe, Brenda
dc.contributor.authorDonnell, Deborah
dc.contributor.authorKrows, Meighan
dc.contributor.authorZwane, Zinhle
dc.contributor.authorBukusi, Elizabeth
dc.contributor.authorPanchia, Ravindre
dc.contributor.authorLouw, Cheryl
dc.contributor.authorMwelase, Noluthando
dc.contributor.authorSelepe, Pearl
dc.contributor.authorSenne, Melissa
dc.contributor.authorNaidoo, Logashvari
dc.contributor.authorChihana, Rachel
dc.contributor.authorKasaro, Margaret
dc.contributor.authorNuwagaba-Biribonwoha, Harriet
dc.contributor.authorKotze, Philip
dc.contributor.authorGill, Katherine
dc.contributor.authorMacDonald, Pippa
dc.contributor.authorvanHeerden, Alastair
dc.contributor.authorBosman, Shannon
dc.contributor.authorJaggernath, Manjeetha
dc.contributor.authordu Preez, Phillip
dc.contributor.authorWard, Amy
dc.contributor.authorPeters, Remco P H
dc.contributor.authorDelany-Moretlwe, Sinead
dc.contributor.authorEt.al
dc.date.accessioned2024-12-16T09:34:17Z
dc.date.available2024-12-16T09:34:17Z
dc.date.issued2024-12
dc.description.abstractAdolescent girls and young women (AGYW) account for two-thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre-exposure prophylaxis (PrEP) but low adherence, which might be improved by point-of-care adherence monitoring with tailored counselling. From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16-30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir-based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point-of-care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real-time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression. Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21-27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0-96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point-of-care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27-1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41-1.98). Observed HIV incidence was 1.38/100 person-years (95% CI 0.97-2.08). Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow-up. The use of a novel point-of-care tenofovir assay with tailored real-time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study. clinicaltrials.gov NCT05746065.
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/9729
dc.language.isoen
dc.publisherJohn Wiley and Sons Inc
dc.titleHigh recent PrEP adherence with point-of-care urine tenofovirtesting and adherence counselling among young African women:results from the INSIGHT cohort
dc.typeArticle
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